Individuals with spinal cord injuries and disorders (SCI/D) have an elevated risk of death with community-acquired pneumonia [1], and there may be elevated risk with coronavirus disease 2019 (COVID-19). The Veterans Health Administration (VHA) SCI/D National Program Office oversees health care services received by over 24,000 Veterans with SCI/D at 170 medical centers and more than 1000 outpatient care sites. In coordination with the VHA Support Service Center, the National Program Office maintains the VHA SCI/D Registry, which identifies Veterans who have received health care services from the VHA SCI/D System of Care. To support outreach and prevention activities in the response to the current COVID-19 pandemic, the National Program Office developed operational reports showing COVID-19 infection status as determined by occurrence of a positive laboratory test performed by VHA or by entry of a non-VHA lab result. Additional registry data including demographics, neurologic classifications, comorbidities, and geographic setting were used to determine a preliminary infection risk category and severity risk category for each SCI/D Veteran. These reports were developed in March 2020 and made available to VHA SCI/D Centers on April 7, 2020. The objective of this analysis was to describe case fatality of COVID-19 infection in Veterans with SCI/D as determined using these operational reports.

Between March 9, 2020 and June 30, 2020, COVID-19 was identified in 140 of 17,452 Veterans with SCI/D, inclusive of traumatic and nontraumatic etiologies and excluding both multiple sclerosis and amyotrophic lateral sclerosis. The mean (SD) age of those with infection was 67 (12) years. The racial composition was White: 80 (57%), Black: 50 (36%), and other/declined/unknown 10 (7%). For those with neurologic classifications recorded (n = 82), the combined neurological level and American Spinal Injury Association Impairment Scale (AIS) categories were: C1–C4 tetraplegia AIS A–C: 13 (16)%; C5–C8 tetraplegia AIS A–C: 14 (17%); paraplegia AIS A–C: 15 (18%); all AIS D: 40 (49%). Infections were identified in Veterans from 63 VHA health care systems. Inpatient care was received by 67 of 140 (48%) Veterans in VHA hospitals and by an unknown number of Veterans in other inpatient settings.

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